Managing Subretinal Bands in Proliferative Vitreoretinopathy

A subretinal proliferation band is a form of proliferative vitreoretinopathy (PVR) that occurs after a rhegmatogenous retinal detachment. In this process, retinal pigment epithelial (RPE) cells migrate from their normal monolayer into the subretinal space and undergo metaplasia into macrophages and myofibroblastlike cells that proliferate as sheets. Retinal glial cells also contribute (more often forming white nonpigmented sheets). These pigmented sheets contract and form subsequent holes within these sheets or scroll into subretinal bands.

In less extensive cases, the subretinal band can be accessed via a retinotomy and removed. Diathermy should be applied adjacent but not on the band and the retinotomy can be used to access the band with a hand over hand bimanual technique.

However, in more extensive cases a retinectomy is the only way to access these bands. This patient presented under oil after his third retinal detachment surgery with vision of hand motion. The examination revealed extensive subretinal membranes through the macula with a macular detachment under oil and laser up to the posterior pole.

In the following video you can see how this case was managed.

Posteroperatively, the vision was count fingers at week 1 with a flat retinectomy under oil.

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